Transplacental infection of the fetus is rare during pregnancy. Intrauterine HSV infection has uncommonly been associated with skin lesions, chorioretinitis, microcephaly, hydranencephaly , and microphthalmia [1,2].
While primary HSV infections in the first trimester are associated with higher rates of spontaneous abortion and stillbirth .
infection later in pregnancy appears more likely to be associated with preterm labor or growth restriction.
Of greatest concern is the risk of primary infection acquired at birth which could lead to herpetic meningitis. The infection rate is
34 to 80% for infants born vaginally during a primary infection. The risk falls to 1 to 5% for infants born
vaginally during a recurrent infection [4, 5,6].
Cesarean section is recommended for all women in labor with active
genital lesions or prodromal symptoms such as vulvar pain.
For patients with preterm premature rupture of membranes remote from term complicated by
recurrent maternal HSV infection, the risks of prematurity should be weighed
against the risk of neonatal HSV disease in considering expectant management.
Prophylactic treatment with antiviral agents (eg, acyclovir) may be considered
if expectant management is chosen [6-8].
1. Shepard TH. Catalog of Teratogenic Agents pp 1323. 9th ed.Baltimore,
MD: Johns Hopkins University Press, 1998
2. Hutto C, Arvin A, Jacobs R, Steele R, Stagno S, Lyrene R, Willett L, Powell D, Andersen R, Werthammer J, et al.
Intrauterine herpes simplex virus infections.
J Pediatr. 110:97-101, 1987
3. Freij BJ, Sever JL: Herpesvirus infections in pregnancy: Risks to embryo, fetus, and neonate. Clin Perinatol 15:203-231, 1988
4. Brown ZA, Vontver LA, Benedetti J, et al: Effects on infants of a first episode of genital herpes during pregnancy. N Engl J Med 312:1246, 1987
5. Stagno S, Whitley RJ: Herpesvirus infections of pregnancy. Part II: Herpes simplex, virus and varicella zoster infections. N Engl J Med 313:1327-1330, 1985
6.ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical
management guidelines for obstetrician-gynecologists
Obstet Gynecol 2007
ACOG Practice Bulletin. Clinical management guidelines for
obstetrician-gynecologists. No. 82 June 2007. Management of herpes in pregnancy.
Obstet Gynecol 2007
Major CA, Towers CV, Lewis DF, Garite TJ.
Expectant management of preterm premature rupture of membranes complicated by
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